Over the years of contending with my disease, and its inevitability, many people presented a variety of questions. Most focus on attitude, asking if I am ‘angry’ with the hand dealt me. Others focus on treatment approaches, often accompanied with ‘treatment’ suggestions saying, ‘what do you have to loose’? The there are the religious, often times being the principal question and at other times coming as a follow-up to some precursor, some question, or series of questions, about my disease and its possible outcomes. All are interesting in their own right, but of all of them, answer the religious questions seems to ‘provoke’ the most confusion. Ultimately all focused on the religious precipitate down to the idea of why I do not regularly attend church, why I do not offer some extension of faith, some request for forgiveness for whatever I may so ‘require’. I think, or so it seems, the peace I’ve found within myself confounds many, confuses them for it seems I surely harbor anger about my fate. (more…)

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Well the checkup has come and gone with the suspected outcome confirmed, the Zytiga has no effect. The more surprising thing is that my PSA, while on the Zytiga, rose more dramatically, perhaps stunningly, than ever before. With my last PSA being 9.8, I projected a PSA somewhere in the high teens or low twenties, an expected 2.5 or 3 times higher than previously measured. As it turned out, it came back significantly higher, it came back at 40.2, an increase of more than four times the previous value. While I had prepared to discuss a marginal increase the a decision on whether to continue with the Zytiga, but instead the conversation went directly to alternatives, the last possible options left to defer advance of the disease. It was an interesting conversation, one which included my health care proxy, my younger nephew.

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Last night I had an interesting dream, something I rarely do these days, not the interesting part, but the dreaming in general. It was rather pervasive, hanging on and returning with my regular awakenings. It was about my funeral, the planning of which has been something at the fore of my mind lately. While, in a large part, I believe these things to be for those left behind, I have asked to ‘direct’ several aspects. Principally, I have asked a number of people to ‘carry me’, having given each an assigned spot. I also asked for a Masonic service, it does attend to the core of my religious beliefs. I asked the affair not be something morbid, shrouded in the darkness of despair, but rather an acknowledgement that death is part of life. As part of the latter I suggested, and have begun asking, certain people say a few words, remembrances of a good times had or simply any ‘words of wisdom’. Lastly, I requested my niece coordinate the event. Now, back to the dream.

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As most know, every three months I go in for a checkup which necessarily includes a PSA measurement. The interesting thing with the last few checkups is, based on bone and CT scans done in early February, no longer reflects my disease burden. Another way of saying this is that I have much more disease than one would expect with the most recent PSA of 9.8 (February), slightly less than the 4.6 measured in November. This checkup will also come after having been on a new drug, approved in August 2012, called Zytiga. While it is still early in the treatment, by all accounts, as described in my last post, the drug is not even slowing progression of the disease. Certainly the PSA will be the determining factor, but if rising at the same rate, or faster, than the last measurement, it will be the end of the Zytiga trial, at least in my view. That said, early indications from Paul are that he will want to continue with the drug under the pretext it has not had sufficient time to ‘do its magic’. I am guessing he will lack the data to defend that position and thus it will be time to move to the next option.

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Throughout my life I have incurred any number of injuries, many found well after the fact. Many injuries were simply endured, falling under my omnipresent mantra of ‘ignore it and it will go away’. When much younger I did things like sew a deep cut in one of my fingers, knowing they were necessary given I could see the ligaments moving within the cut. In other situations I ignored things, a broken ankle for one. However, things always seemed to be different with my cancer, because from the beginning it always told me something was wrong. I sought initial treatment because the cancer caused me to loose my ejaculate and on other occasions it told me different things. Over time I have learned to listen to my body and with that has come a number of discoveries.

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I spent the majority of my youth working on a farm, a dairy farm. With it came the long days of milking cows and completing all the chores in-between. In the spring add to those chores the fitting of ground, readying it for planting crops, oats, corn and some others. This was followed by summers focused on making hay, baling and storing as many as 1,800 bales on some days. It was a labor of love and instilled within me a strong work ethic, the idea or characteristic of hard work being part of life. While many of my mates played sports and worked out to gain strength and endurance, I found those same things in my work. With all of that work, all of the repetitions of handing 50 pound bales of hay, pitching 3-4 manure spreaders full when cleaning out that accumulated over a winter. I was strong, had endurance and felt good when challenged with physical work. It is that same work ethic applied to my professional career that enabled me to succeed, to perform at above average levels. In all of my time I really never fathomed my working as something that was not my choice, but it would seem cancer is changing the paradigm.

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In a high school biology class during a discussion about genetics we began discussing time, more specifically probabilities for longevity based on our phenotypic indicators. Some in the class expressed a familial history of heart disease, some of grandparents and great grandparents who lived well into their nineties. Others, like the teacher himself, expressed a plethora of maladies that plagued their families, not the least of which being cancer. For me, at the time, I knew of two major issues within my lineage, a maternal grandmother who died of some form of reproductive cancer in her forties and a paternal grandfather who died of a massive coronary in his forties. Together with these issues was mental illness with my mother and among my maternal aunts and uncle, Alzheimer’s. Paternally it seemed nearly all my father’s siblings had some form of cardiac irregularity. For me, it would have seemed the writings suggested I, and my siblings, would not likely live to ‘ripe old ages’, but rather be surviving on borrowed time once turning sixty-five or seventy. With the discussion I saw time, my time, in terms of decades and found it similarly expired.